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APPLICATION FOR BUILDINGPERMIT
COUNTY OF LOS ANGELES_ _ BUILDING AND SAFETY = �-
FOR APPLICANT TO FILL IN_ _ ADDRIESS
BUILDING {
ADDRESS �'/j LOCALITY
NEAREST 0
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CIZIP ' CROSS ST
O OF BLDGS Q - ASSESSOR w}'
SIZE OF LOT NOW ON LOT MAP BOOK a T PAGE PARCEL
/� ' DISTRICT GROUP TYPE t y FIRE P ESS�D BY
TRACT 7 BLOC4W //� LOTIQO�IZ3 �r-;�/ -^ - CONST ONE
_ STATISTICAL CLASSIFICATION SEWER MAP
ADDRESS if `+
-CLASS NO lefQDWELL UNITS BK PG
CITY / ZIP +
ARCHITECT OR TEL VALUATION $ 'r `
ENGINEER + .i--; - NO- ra -- 7O spa
ADDRESS _ BLDG SETBACK FROM
FRONT PROP LINE OF (STREET)
CONTRACTe /C N�Y� '" TOTAL SETBACK FROM TYPE OF EXISTING
LIC HIGHWAY + YARD = FRONT PROP LINE HIGHWAY WIDTH '
ADDRESS NO
LIC �s + _ --
CITY CLASBLDG SETBACK FROM +
NONS A CT LEND G- SIDE PROP LINE OF (STREET) �'
HIGHWAY + YARD TOTAL SETBACK FROM TYPE OF EXISTING d
SIDE PROP LINE HIGHWAY WIDTH 0
/ yr u
SQ FT NO OF NO OF CHECK + _ '
SIZE — STORIES FAMILIES ONE I I - 0
USE ZONE MAP _
DESCRIPTION OF WORK NEW �i1'� NO
s Cv SPECIAL ILS Ov ADD ❑ !� CONDITIONS, r r 1A
ALTER ❑ FINAL I Y Z
REPAIR Q DATE 9 9 2 9 A
USE OF
EXISTING BLDG w .. _ s . C 0 0 0 0 0
D"EMOL �
APPLICANT TEL r 2 - 551L50
®S oto55&5070:
I HEREBY A WLEDGE TH I HAV EAD S APPLICATION AND STATE OF O {Y{�� 0416-80
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THAT THE AB IS CORRECT D AG TO MPLY WITH ALL ORDINANCES t, 1i1
AND LAWS REGULATING BUILDING CONSTRUCTION I CERTIFY THAT IN DOING THE ._. /�"..y i v t s
WORK AUTHORIZED HEREBY I WILL NOT EMPLOY ANY PERSON IN VIOLATION OF O
THE LABOR CODE OF THE STATE OF CALIFORNIA IN RELATING TO WORKMEN S COM „ Z ,.
PENSATION INSURANCE
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SIGNATURE OF
PERMITTEE
ADDRESS + Z
.• ^TEL .. w. -2
CITY NO < t
p i r +
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PC Fee$ PermitFee i O w >
Issuance Fee
Total Fee 5SY,So